Key result
Aortic valve bypass decreases mean gradients but carries ~13% perioperative mortality in high-risk aortic stenosis.
Why the study?
Does aortic valve bypass (AVB) surgery improve hemodynamics and provide a safe alternative in high-risk patients with symptomatic aortic stenosis?
Observational (n=31)
Does aortic valve bypass (AVB) surgery improve hemodynamics and provide a safe alternative in high-risk patients with symptomatic aortic stenosis?
Aortic valve bypass surgery provides effective hemodynamic relief of aortic stenosis with acceptable perioperative risks in high-risk patients, particularly those with patent bypass grafts or porcelain aortas.
May relieve gradients in select high-risk aortic stenosis cases; leaves open safety and role as alternative without prospective trials.
BACKGROUND: Aortic valve bypass (AVB; apicoaortic conduit) surgery relieves aortic stenosis (AS) by shunting blood from the apex of the left ventricle to the descending thoracic aorta through a valved conduit. We have performed AVB surgery as an alternative to conventional aortic valve replacement for high-risk AS patients. METHODS AND RESULTS: Between 2003 and 2007, 31 high-risk AS patients were treated with AVB surgery. Twenty-two patients (71%) were undergoing reoperation with patent coronary bypass grafts, and 5 (16%) had a porcelain ascending aorta. The average age was 81 years. Cardiopulmonary bypass was used for 19 of 31 patients (61%); the median duration of cardiopulmonary bypass was 19 minutes. Cross-clamp time for all patients was 0 minutes. Perioperative mortality was 13% (4 of 31 patients); no perioperative deaths occurred in the last 16 consecutive patients. One patient experienced a stroke related to intraoperative hypotension. No strokes have occurred during follow-up. Renal function was unchanged after AVB (preoperative creatinine, 1.3+/-0.5 mg/dL; postoperative creatinine, 1.2+/-0.5 mg/dL). The mean gradient across the native aortic valve decreased from 43.5+/-15 to 10.4+/-5.4 mm Hg. Echocardiographically determined conduit flow expressed as a percentage of total cardiac output was 72+/-12%. CONCLUSIONS: AVB surgery is an important therapeutic option for high-risk patients with symptomatic AS. Ventricular outflow is distributed in a predictable fashion between the conduit and the left ventricular outflow tract, and AVB surgery reliably relieves AS. Stroke and renal dysfunction were uncommon.
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Gammie et al. (2008) conducted an observational in Aortic stenosis (n=31). Aortic valve bypass (AVB) surgery was evaluated on Perioperative mortality. Aortic valve bypass surgery in high-risk patients with aortic stenosis resulted in 13% perioperative mortality and decreased the mean aortic valve gradient from 43.5 to 10.4 mm Hg.
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